Search

An introduction is presented in which author discusses articles on topics including focuses on promoting environmental sustainability and an opportunity to share projects related to improve the environmental footprint of critical care.

This paper reports the findings from a study commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB), entitled Evaluation of the Effectiveness of Educational Preparation for Critical Care Nursing. One aim of the study was to generate evidence that incorporated the national perspective on the priorities for core competencies and a national threshold standard of the ENB critical care clinical awards. Although these courses are no longer validated by the professional statutory body, the findings illuminate some key insights into the current challenges facing providers and consumers of critical care education as well as into implications for all post-registration education provision. The paper outlines how the study data were collected, how the core competendes were generated and the national consultation exercise and the levers and barriers that affect the introduction of core competencies. Other aspects of the study data are reported elsewhere (Scholes and Endacott, 2002). [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one by Morgan on how nurses can maintain clinical credibility after being promoted to senior posts, one by Papathanassoglu and Mpouzika on moral reflection in health care during a global economic crisis and one by Gartemann et al. on the time nurses spend implementing a single protocol.

• Intensive care has developed as a speciality since the 1950s, and during this time, there have been major technological advances in health care provision, leading to a rapid expansion of all areas of critical care • The ongoing problem in recruiting qualified nurses in general has affected, and continues to be a problem for, all aspects of critical care areas • During the past decade, nursing practice has evolved, as qualified nurses have expanded their own scope of practice to develop a more responsive approach to the complex care needs of the critically ill patient • The aim of this paper is to present the British Association of Critical Care Nurses (BACCN) position statement on the role of health care assistants involved in direct patient care activities, and to address some of the key work used to inform the development of the position statement. [ABSTRACT FROM AUTHOR]

The article highlights the contributions and value of the critical care-trained research nurse in pediatric intensive care (PIC) during the coronavirus disease-2019 (COVID-19) pandemic. Topics covered include the response of the PIC to the health crisis, the challenges associated with conducting research nursing during COVID-19, and the opportunities presented by the pandemic to both research nursing and nursing research.

The author reflects on the importance of learning the family-centered care among pediatric intensive care unit nurses in Great Britain. The author suggested that nurses must have clinical judgment, wisdom, and skill for them to carry out their role as medical personnel. He explained that, family centered care is the creation of emotional labor and at the same time to instill a sense of hope among their patients.

The article comments on the report "Critical care nursing: Towards 2015," by C. Hurley, published in the Volume 13 of "Nursing in Critical Care." It mentions that a sign of a maturing profession and discipline is the critical engagement of debate and constructive criticism, which opens new horizons and helps advance ones thinking and vision.

The comprehensive review sought to examine the impact of Critical Care Nurse Practitioner models, roles, activities and outcomes. The Medical Literature Analyses and Retrieval (MEDLINE), The Cumulative Index of Nursing and Allied Health Literature (CINAHL); PubMED; PROQUEST; ScienceDirect; and the Cochrane database were accessed for the review. Alternative search engines were also included. The search was conducted with the key words: critical care, intensive care, acute, adult, paediatric, trauma, disease management programs, disease management, case management, neonatal, cardiology, neurological, retrieval, transfer and combined with Nurse Practitioner. From the identified 1048 articles 47 studies were considered relevant. Internationally, Critical Care Nurse Practitioners were located in all intensive care areas and services including post intensive care discharge follow-up, intensive care patient retrieval and transfers and follow-up outpatient services. The role focussed on direct patient management, assessment, diagnosis, monitoring and procedural activities. Critical Care Nurse Practitioners improved patient flow and clinical outcomes by reducing patient complication, morbidity and mortality rates. Studies also demonstrated positive financial outcomes with reduced intensive care unit length of stay, hospital length of stay and (re)admission rates. Internationally, Critical Care Nurse Practitioners are demonstrating substantial positive patient, service and nursing outcomes. Critical Care Nurse Practitioner models were cost effective, appropriate and efficient in the delivery of critical care services. In Australia, there was minimal evidence of Critical Care Nurse Practitioner impact on adult, paediatric or neonatal intensive care units. The international evidence suggests that the contribution of the role needs to be strongly considered in light of future Australian service demands and workforce supply needs. In Australia, the Critical Care Nurse Practitioner role and range of activities falls well short of international evidence. Hence, it was necessary to scope the international literature to explore the potential for and impact of the Critical Care Nurse Practitioner role. The review leaves little doubt that the role offers significant potential for enhancing and contributing towards more equitable health services. [ABSTRACT FROM AUTHOR]

BACKGROUND: Renal replacement therapy (RRT) is now offered as a routine treatment in most intensive care units (ICU) in the UK for patients suffering from acute kidney injury (AKI). It is important for all ICU staff to understand the underlying principles of the available therapeutic options and the possible complications thereof. AIMS AND OBJECTIVES: The objective of this review was to provide an accessible theoretical and practical update on the management of RRT. In addition to a detailed discussion of the underlying principles and indications for the various modes of RRT, we will discuss the assessment of kidney function, possible complications and anticoagulation during RRT, following a review of the current literature. SEARCH STRATEGIES: Pubmed, Medline and the Cumulative Index to Nursing and Allied Health Literature were searched using the keywords renal function, RRT, dialysis, renal failure kidney injury, together with intensive care, intensive therapy and critical care. We included only studies published in English from 1998 to 2008 and from these identified and included additional publications. The 12 most relevant publications are referenced in this review. CONCLUSION: AKI is associated with increased mortality in ICU, and RRT should be considered early in the disease process. Continuous haemofiltration is the most common modality of treatment in this group of patients, and a detailed knowledge of the management of such patients is required. [ABSTRACT FROM AUTHOR]

Disturbed sleep and sleep deprivation is common in patients in critical care settings. Noise and inappropriate use of light/dark cycles are two of the causes of sleep interruptions. The purpose of the study was to evaluate eye masks and earplugs to help control patients’ exposure to noise and light within the critical care environment. An intervention study using a two group post-test quasi-experimental design of high dependency patients within a cardiothoracic critical care unit was undertaken by a group of critical care nurses. Sleep assessment rating scales and open-ended questions were used to obtain patients’ reported experiences of their sleep. Patients self-selected into either an intervention or non-intervention group. Sixty-four patients consented to take part in the study, 34 patients tried the interventions earplugs and eye masks and many found they improved sleep. However, noise was still a factor preventing sleep for both groups of patients. Mixed reports were found with the interventions from very comfortable to very uncomfortable. At a cost of £2·50/patient, earplugs and eye masks were a relatively cheap intervention with notable improvements for some critically ill patients. Further research is required with a larger sample size, plus an examination of both earplugs and eye masks separately. Offering patient’s earplugs and eye masks to improve sleep should be considered as a matter of routine nursing practice, this should include time to show patients how to use and try them out for comfort. [ABSTRACT FROM AUTHOR]

Equipment and procedures developed during the past several decades have made the modern intensive care unit (ICU) the hospital’s most technologically advanced environment. In terms of patient care, are these advances unmitigated gains? This study aimed to develop a knowledge base of what it means to be critically ill or injured and cared for in technologically intense environments. A lifeworld perspective guided the investigation. Nine unstructured interviews with intensive care patients comprise its data. The qualitative picture uncovered by a phenomenological analysis shows that contradiction and ambivalence characterized the entire care episode. The threat of death overshadows everything and perforates the patient’s existence. Four inter-related constituents further elucidated the patients’ experiences: the confrontation with death, the encounter with forced dependency, an incomprehensible environment and the ambiguity of being an object of clinical vigilance but invisible at the personal level. Neglect of these issues lead to alienating ‘moments’ that compromised care. Fixed at the end of a one-eyed clinical gaze, patients described feeling marginalized, subjected to rituals of power, a stranger cared for by a stranger. The roar of technology silences the shifting needs of ill people, muffles the whispers of death and compromises the competence of the caregivers. This study challenges today’s caregiving system to develop double vision that would balance clinical competence with a holistic, integrated and comprehensive approach to care. Under such vision, subjectivity and objectivity would be equally honoured, and the broken bonds re-forged between techne, ‘the act of nursing’, and poesis, ‘the art of nursing’. [ABSTRACT FROM AUTHOR]

Background : Twelve-hour shifts have been illustrated in the literature as being a highly contentious shift pattern. However, it has also been highlighted that there is a distinct paucity of literature solely related to such a shift pattern in critical care areas, where there is high activity and a requirement for multiple and highly significant decision-making situations. It was therefore identified that such an area deserved further exploration. Aim : This study aimed to elicit critical care nurses’ perceptions of working 12-h shifts. Methods : Fifty-four nurses from three critical care areas within a large local NHS teaching hospital currently working 12-h shifts completed a self-administered questionnaire on their perceptions of 12-h shifts. Following on, a focus group interview was conducted to complement this questionnaire in an attempt to further explore these perceptions. Results : From the results of the questionnaire, patient care, job satisfaction, off duty and family life achieved the most positive responses, whereas communication, fatigue and education achieved the most negative. The focus group explored these issues with added comments on work-shy staff, suggestions on shift patterns, breaks and staffing levels. Conclusions : Twelve-hour shifts in critical care areas are suitable shift patterns for nurses, patients and management, provided that they are fundamentally well-managed. [ABSTRACT FROM AUTHOR]

There is little documented knowledge about what is supportive from the perspective of relatives with a critically ill next-of-kin in the intensive care unit (ICU). The aim of the present study was to generate a theoretical understanding of what relatives experience as supportive when faced with the situation of having an adult next-of-kin admitted to critical care. The study was designed using a grounded theory methodology. Interviews were conducted with 29 adult relatives of adult ICU patients in southwest Sweden. Relatives described the need to be empowered and that support was needed to enable them to use both internal and external resources to cope with having a next-of-kin in critical care. To achieve empowerment, the relatives described the need to trust in oneself, to encounter charity and to encounter professionalism. The findings can contribute understanding and sensitivity to the situation of the relatives as well as indicating what form social support should take. It is essential that healthcare professionals understand how important it is for relatives to have control over their vulnerable situation and that they also reflect upon how they would like to be treated themselves in a similar situation. Recommendations for future practice are presented. [ABSTRACT FROM AUTHOR]

Fluid management is a vital component of patient care within the critical care setting; it has a range of indications and applications, one of the most important being to maintain tissue perfusion and safeguard against single/multiple organ failure. Hypovolaemia is a commonly encountered condition within critical care and has the potential to jeopardize tissue perfusion and accelerate the risk of organ failure. In an attempt to optimize the fluid management of patients within the intensive therapy unit, this article outlines the development and implementation of a fluid prescription for ventilated patients with suspected hypovolaemia. [ABSTRACT FROM AUTHOR]

By posing a clinical practice question, this article aims to document and explore the published evidence base supporting nurse-led cardioversion. A literature review was undertaken to determine the best evidence for practice. Five articles and two conference abstracts describing practice were found to be pertinent to the question. Description of the methodology used was a weakness of all the articles studied, with only one article purported to be framed as a research study. The remainder describe a planned change in nursing practice to encompass the delivery of a service previously, organizationally viewed as, physician led. Evaluations of practice were descriptive and supported by audit data in most articles, however, appropriate evidential comparisons were not offered. These articles were critically appraised in relation to safety and efficacy. Whilst the evidence may be seen to be limited and weak, it does add credence to the notion that a nurse with a suitable experiential background and knowledge base can make a significant contribution to the care of this group of patients. It is clearly evident that further developments in practice should be framed within a research context to support and strengthen the evidence base. Four prominent themes emerged from the review, 'change milieu', 'reshaping boundaries', 'nurse-led', 'efficacy of practice', which are modelled into a conceptual framework. Nursing roles are expanding within the cardiological setting, affording practitioners unprecedented practice opportunities within a supportive organizational framework, however, these roles must be subject to appropriate evaluation in order to continue informing a robust evidence base. [ABSTRACT FROM AUTHOR]

This article presents information about Beverly Malone headlines 3-day International Critical Care Event in Cambridge. With over 400 delegates from as far and wide as Australia, Canada, USA, Hong Kong, The Phillipines and Europe and a sell out exhibition, the BACCN 2004 International Conference held jointly with the World Federation of Critical Care Nurses at the University of Cambridge on the September, 13-15th was a resounding success. Indeed, the BACCNs second International Conference has been hailed as the "best ever yet" from many of its satisfied delegates.

• There is a lack of evaluative literature on the use of learning portfolios in nursing • Many students are still unclear on the benefit of using a learning portfolio, and fulfilling the criteria for the portfolios remains low priority • Over a 5-year period, tutors on the Specialist Practitioner Qualification in Critical Care found that there was a wide variety of practice in portfolio use. • There is comparatively little known about how the students perceive the use of portfolios. Therefore, a small descriptive survey took place in 2001/2002 involving 22 previous students, to identify the value of portfolios from the student perspective • Recommendations from this study are given on how to improve portfolio use [ABSTRACT FROM AUTHOR]

This article aims to review the current evidence in relation to acute head injury care. Head injuries are a frequent cause of death and disability in western society with the first 72 h being an important period for prevention of further brain damage. The underlying physiology behind head injury and intracranial pressure will be discussed. The monitoring of intracranial pressure and implications for practice will be addressed. The specialized nursing care and drug therapy management that is necessary for acute head injury patients will be highlighted. Recommendations for practice will be given. [ABSTRACT FROM AUTHOR]

The case of Ms B throws up some interesting issues regarding the role of the nurse in assisting patients in making and implementing their decisions. The High Court transcript makes it clear who the voices with influence in legal matters were, and why the decisions they took were made. Absent from the myriad voices is that of the profession of nursing. Are nurses silenced by professional boundaries, the legal framework or lack of confidence? The concept of nursing advocacy is once again thrown into relief and critical questions need asking about the limits of professional nursing practice. [ABSTRACT FROM AUTHOR]